Mood management across affective states: the hedonic contingency hypothesis

Mood management in positive and negative moods is relevant to a variety of social phenomena and has been especially important in the helping literature. Theorists have predicted that sad people strategically engage in mood management activities more than happy people. However, application of learning principles across affective states led the authors to hypothesize that hedonic rewards are more contingent on scrutiny of hedonic consequences in happy than sad states. Thus, happy people should scrutinize the hedonic consequences of potential behaviors more than sad people. A selective exposure paradigm was used to test this hedonic contingency hypothesis. People in whom happy, sad, or neutral states were induced were asked to choose activities in which to engage. In 3 experiments, happy people based their choices on the affective consequences of those activities more than sad or neutral individuals. Implications for interpreting past work are discussed.

Diagnostic value of anti-neutrophil cytoplasmic and anti-endothelial cell antibodies in early Kawasaki disease

OBJECTIVE

To assess the diagnostic potential of anti-neutrophil cytoplasmic antibodies (ANCA) and anti-endothelial cell antibodies (AECA) to distinguish early Kawasaki disease (KD) from febrile diseases resembling KD.

DESIGN

Case-control study.

SETTING

Tertiary care facility.

PATIENTS

Eighteen patients with KD tested within 2 weeks of disease onset and before immune globulin therapy; 20 control children with fever and at least one other KD criterion; 21 children with noninflammatory disorders (patients scheduled for elective surgery, or after trauma).

METHODS

We detected ANCA by immunofluorescence and enzyme-linked immunosorbent assay (ELISA), and AECA by a cell-ELISA with fixed human umbilical vein endothelial cells.

RESULTS

We found that 7 of 18 patients with KD and 6 of 20 febrile control patients had ANCA (by immunofluorescence or ELISA, p value not significant); 3 of 18 patients with KD and 8 of 20 febrile control patients had AECA (p value not significant). One of three patients with KD who had aneurysms had ANCA; none had AECA.

CONCLUSIONS

The ANCA and AECA tests used in this study did not differentiate early KD from other childhood diseases with which it may be confused.

Monitoring disease activity in juvenile dermatomyositis: the role of von Willebrand factor and muscle enzymes

OBJECTIVE

To assess the usefulness of serial measurement of plasma von Willebrand factor (vWF) and serum levels of muscle enzymes in the detection and prediction of flares of disease activity in children with juvenile dermatomyositis (JDM).

METHODS

Retrospective study of serial measurements of vWF and muscle enzymes in 16 patients with JDM followed for 540 patient-months. Charts were reviewed by an investigator blinded to laboratory results, and disease flare was defined as 2 of worsening function, increasing weakness, increasing muscle enzymes, increasing medication requirements.

RESULTS

vWF was increased on at least one occasion in all but 2 patients with levels up to 4.9 IU/ml (normal 0.5 to 1.5). Laboratory evaluations were available in 23/29 disease flares. The sensitivity (0.85) and specificity (0.45) of vWF to detect disease flare were not better than that of LDH or AST even when muscle enzyme levels were excluded from flare definition. CK and ALT were not significantly associated with disease flare. The risk of flare increased 3-fold after a > 20% increase in AST levels, but vWF did not reliably predict disease flare.

CONCLUSION

Although vWF is associated with disease flares, it does not seem to offer more information than enzyme measurements. LDH and AST were most useful in the detection of a flare, while AST was the only test capable of predicting it.

Relationship between collagen-induced and adjuvant arthritis in the Lewis rat

Adjuvant arthritis (AA) and type II collagen (CII)-induced arthritis (CIA) in the rat serve as models of chronic human arthritis. Adoptive transfer of AA was observed in 21 of 25 Lewis rats given concanavalin A (Con A)-treated spleen cells prepared from animals immunized with Mycobacterium butyricum in mineral oil (complete Freund's adjuvant, CFA). No arthritic changes were noted in rats given spleen cells obtained from donors that had received incomplete Freund's adjuvant (IFA, 0/22), type I collagen in IFA (CI-IFA, 0/6) or CII-IFA (0/28). Administration of spleen cells from IFA, CI-IFA or CII-IFA-injected animals did not modify the development of CIA when these rats were subsequently challenged with CII-IFA. However, partial protection against induction of AA was provided by the transfer of spleen cells prepared from rats immunized with CII-IFA (6/11) but not by those obtained from rats injected with IFA (1/15) or CI-IFA (0/3). Rats that did not develop clinically evident arthritis following the administration of spleen cells prepared from CFA-injected rats were also resistant to AA induction by CFA. Pre-treatment of rats with a synthetic peptide, corresponding to amino acids 180-188 of the Mycobacterium 65 kD heat shock protein (65 kD HSP), significantly delayed the onset of AA, but not that of CIA. Disease-specific resistance to AA, provided by spleen cells prepared from rats injected with CII-IFA and by pre-treatment with the 65 kD HSP 180-188 peptide, may result from the induction of protective tolerance to arthritogenic epitopes present in the Mycobacterium and CII preparations.

Iris protein antibodies in serum of patients with juvenile rheumatoid arthritis and uveitis

Homogenates of bovine iris were fractionated by gel filtration chromatography, and the column-eluted proteins were probed with pooled sera obtained from patients with pauciarticular juvenile rheumatoid arthritis (JRA). The serum pool prepared from patients with pauciarticular JRA and a history of anterior uveitis, but not from those without the eye disease, contained IgG antibodies which bound a low molecular weight iris antigen (LMW-IA) as measured by a modified ELISA. LMW-IA was protease-sensitive and contained at least four proteins of approximate molecular weights of 16, 13, 9 and 6.5 kD with no uronic acid or carbohydrate. Analysis of individual patient sera for IgG anti-LMW-IA antibody demonstrated that 1/20 (5%) pediatric non-rheumatic disease controls (NRDC), 1/19 (5.3%) non-uveitic pauciarticular JRA patients and 6/21 (28.6%) uveitic pauciarticular JRA patients were positive by ELISA. Levels of anti-LMW-IA antibody did not correlate with serum IgG concentration, the presence of IgG antibody to soluble retinal S antigen (S antigen) or reactivity to the low molecular weight fraction of bovine choroid (LMW-C). Ten of 21 (47.6%) children with pauciarticular JRA and uveitis had serum antibody that reacted with LMW-IA and/or retinal S antigen as compared to 1/20 (5%) NRDC patients and 3/19 (15.8%) patients with pauciarticular JRA uncomplicated by uveitis. Analysis of patient immunoreactivity to proteins of the anterior uveal tract may provide a greater understanding of pathogenic features related to arthritis-associated eye disease.

Autoantibodies in chronic arthritis of childhood: relations with each other and with histocompatibility antigens

BACKGROUND

Studies have shown the presence of either antibodies to histone or anticardiolipin antibodies in some forms of childhood chronic arthritis. The relation between these autoantibodies has not been previously reported, however, and the immunogenetics of their association with childhood arthritis has not been studied.

METHODS

The interrelation of fluorescent antinuclear antibodies, antibodies to histone, and anticardiolipin antibodies and their associations with histocompatibility antigens (HLA) were studied in 114 children with chronic arthritis (45 children with pauciarticular onset juvenile chronic arthritis (JCA), 22 with polyarticular onset JCA, 13 with systemic onset JCA, and 34 with juvenile psoriatic arthritis (JPsA). Antibodies to histone and anticardiolipin antibodies were determined in 108 children. HLA antigens (A, B, C, and DR) were studied in the 83 white children.

RESULTS

Antibodies to histone occurred in 0% (systemic onset JCA) to 42% (uveitis negative, pauciarticular onset JCA), and anticardiolipin antibodies in 26% (JPsA) to 55% (polyarticular onset JCA) of patients. Only 12 patients (11%) had both antibodies to histone and anticardiolipin antibodies. Neither antibodies to histone nor anticardiolipin antibodies associated with the type of arthritis. Neither of these antibodies alone associated with uveitis. Antibodies to histone were associated with HLA-A2, probably reflecting the known association of HLA-A2 with pauciarticular onset JCA. There was no other HLA association. Fluorescent antinuclear antibodies occurred most often in patients with uveitis; however, the occurrence of fluorescent antinuclear antibodies in patients with pauciarticular onset JCA (the group most at risk for uveitis) was not significantly greater in children with uveitis than in those without uveitis (100 and 88% respectively).

CONCLUSIONS

Although antibodies to histone and anticardiolipin antibodies often occur in serum samples from patients with JCA and JPsA, they rarely occur together. Their presence does not associate with uveitis. This study did not show any strong evidence that production of either antibodies to histone or anticardiolipin antibodies in patients with JCA or JPsA is under the control of the histocompatibility locus.

Idiopathic musculoskeletal pain syndromes in children

Between 1982 and 1990, 81 children with localized or diffuse musculoskeletal pain, for which no cause could be found were seen in a pediatric rheumatology clinic. Forty-one children had localized idiopathic pain and 40 had diffuse idiopathic pain. Twenty-four of the patients with localized idiopathic pain fulfilled criteria for definite reflex neurovascular dystrophy. Thirty-five patients with diffuse idiopathic pain fulfilled criteria for fibromyalgia. Four patients with localized idiopathic pain (10%) developed diffuse idiopathic pain during followup; four patients with diffuse idiopathic pain (10%) had a history of localized idiopathic pain and one patient had previously been diagnosed as having Tietze's syndrome. Recurrences or persistence of pain was very common. Many children had potentially important stressors including single parent families, histories of sexual abuse, and learning difficulties. Idiopathic musculoskeletal pain is a common cause of referral to a pediatric rheumatology clinic and is often associated with significant morbidity.

Autoantibody production after cardiopulmonary bypass with special reference to postpericardiotomy syndrome

A prospective study of children undergoing open heart surgery with cardiopulmonary bypass showed that many of them produced autoantibodies. No association was found between these antibodies, including anticardiolipin antibodies, and the occurrence of postpericardiotomy syndrome.

SEA syndrome revisited: a longterm followup of children with a syndrome of seronegative enthesopathy and arthropathy

Thirty-six of the 39 children originally described with the syndrome of seronegative enthesopathy and arthropathy, followed for a mean of 11 years after symptom onset, were found to have had a widely varied clinical course. Twelve of the 23 patients (52%) who originally did not have a seronegative spondyloarthropathy developed definite (6) or possible (6) seronegative spondyloarthropathies. The development of a seronegative spondyloarthropathy was associated with HLA-B27 (p = 0.0004) and the presence of arthritis (rather than arthralgia only) at the time of the original report (p = 0.05). For patients with arthritis, the development of a seronegative spondyloarthropathy was associated with arthritis onset after 5 years of age (p = 0.01).

Persistent antinuclear antibodies in children without identifiable inflammatory rheumatic or autoimmune disease

One hundred eight children with musculoskeletal pain considered not to be due to an autoimmune or inflammatory disease had an antinuclear antibody (ANA) test performed. Twenty-four of these children were ANA positive on HEp-2 cell substrate at a screening serum dilution of 1:20. A positive ANA test persisted in 21 of 24 of the patients over a mean time period of 38 months (range 1 to 103 months). No sera from any patient at initial evaluation had anti-DNA antibodies by radioimmunoassay or by indirect immunofluorescence on Crithidia luciliae. One patient recently developed elevated anti-DNA (radioimmunoassay) antibodies but still has a negative assay on C luciliae. Four patients had antibodies to core histones by immunoblotting. None had antibodies to Sm, RNP, Ro (SS-A), or La (SS-B) by counterimmunoelectrophoresis. No patient developed an overt inflammatory or autoimmune disease during a mean follow-up period of 61 months (range 13 to 138 months). A child with musculoskeletal pain and a positive test for ANA, but with no clinical evidence at presentation of inflammatory or autoimmune disease, is at low risk of imminently developing such a disease.

Juvenile ankylosing spondylitis

We are beginning to understand the clinical nature of JAS, its relationship with other SSA, and factors involved in its pathogenesis. Clinical data may now allow early recognition of JAS through the identification of children with the SEA syndrome or chronic arthritis associated with the HLA-B27. Comparative clinical studies of the prevalence of the disease and the role of immunogenetic, racial and environmental factors are needed. It may be necessary to review current criteria for the diagnosis of JRA and to develop similar criteria for the diagnosis of AS in childhood and adolescence.

HLA-B27 and rheumatic diseases of childhood

In childhood, the histocompatibility antigen HLA-B27 is associated with juvenile ankylosing spondylitis, Reiter's syndrome, and the sacroiliitis of juvenile psoriatic arthritis, and inflammatory bowel diseases. The low frequency of signs or symptoms of spine or sacroiliac joint disease at onset differentiate these disorders from their adult counterparts and make early diagnosis difficult. The presence of enthesitis and the absence of rheumatoid factor and antinuclear antibody suggests the diagnosis of one of the seronegative spondyloarthropathies. The mechanisms by which HLA-B27 positivity confers susceptibility to disease are uncertain. To date, no genetically determined differences in the HLA-B27 molecule, or in the T cell receptor which recognizes antigen in the context of HLA-B27, have been consistently shown to be associated with the presence of disease. There is no explanation for the onset of disease in childhood in some individuals.

Ocular complications of rheumatic diseases of childhood

The association between inflammatory ocular and articular disease is a strong one, although the pathogenesis of this relationship is obscure. For the physician or surgeon caring for children with chronic arthritis, awareness of the risk of chronic asymptomatic anterior uveitis is essential if early diagnosis, treatment, and prevention of visual impairment are to be accomplished. This is particularly true for children with pauciarticular-onset juvenile rheumatoid arthritis or psoriatic arthritis. Acute symptomatic anterior uveitis is characteristic of disorders such as ankylosing spondylitis. Whereas this disease is initially more unpleasant for the child, it has a good long-term prognosis.

Renal disease in chronic arthritis of childhood. A study of urinary N-acetyl-beta-glucosaminidase and beta 2-microglobulin excretion

Urinalyses of randomly obtained samples from children with various types of chronic arthritis revealed proteinuria in 2.3% of patients, hemoglobinuria in 3.5%, erythrocyturia in 4.1%, and leukocyturia in 5.3%; these frequencies are within the range found by screening school children. However, raised urinary levels of N-acetyl-beta-glucosaminidase and/or beta 2-microglobulin (both sensitive measures of renal tubular damage) were found more frequently in children with chronic arthritis than in controls (P less than 0.0001). Abnormalities of either N-acetyl-beta-glucosaminidase or beta 2-microglobulin excretion were associated with active arthritis as measured by physician global estimate of disease activity, with a polyarticular onset of juvenile rheumatoid arthritis, and with the use of slow-acting antirheumatic drugs or the concurrent use of more than 1 nonsteroidal antiinflamtory drug. Abnormal renal tubular function appears to be common in chronic arthritis of childhood. The long-term consequences of this abnormality remain to be elucidated.

The pulmonary manifestations of childhood onset systemic lupus erythematosus

Pleuropulmonary disease in childhood onset SLE is common. It may be insidious or present as a life threatening event. North American Indian children in our population appear to be at high risk for severe lung disease. Pulmonary symptoms are present in the majority of children at some time during their disease course and pulmonary function studies are abnormal in the majority of patients. The pulmonary manifestations and frequency of occurrence in childhood appear to be similar to that described in adult onset SLE. Although pulmonary function studies do not correlate well with pulmonary symptoms, these studies provide objective quantification of the type and severity of the functional lesion. Serial tests may be helpful in monitoring disease activity in childhood SLE.

Liver disease in neonatal lupus erythematosus

We report the cases of neonatal lupus erythematosus associated with significant hepatic involvement in three living infants and in one infant who died 3 hours after delivery. The three living infants had neonatal cholestasis as a major component of their clinical findings. Pathologic changes included giant cell transformation, ductal obstruction, and extramedullary hematopoiesis. Liver involvement has been noted incidentally in children with neonatal lupus erythematosus, but it has generally been attributed to hemodynamic compromise as a result of congenital heart block or systemic toxic reactions. We speculate that neonatal hepatitis proceeding to hepatic fibrosis may occur in neonatal lupus erythematosus, analogous to the occurrence of "idiopathic" congenital heart block. The neonatal hepatitis associated with neonatal lupus erythematosus is a form distinguishable from the "idiopathic" group. Liver involvement may be more common than was previously recognized, and prospective studies to look for maternal autoantibodies in idiopathic neonatal liver disease should be undertaken.

Maternal autoantibodies and fetal disease

We have examined the relationships between maternal connective tissue disease (CTD), fetal and neonatal health, and the presence of specific autoantibodies: antinuclear antibodies (ANA), anti-Ro, antiLa, anti-Sm, anti-RNP, anti-DNA, and anticardiolipin (ACL) in 27 mothers with CTD (Group A), and 10 asymptomatic mothers of babies with complete congenital heart block (CCHB), or cardiac arrhythmias (Group B). Compared to 100 normal pregnant controls, autoantibodies were significantly more common in both Group A (96.3%, p less than 0.0005) and Group B (70%, p less than 0.0005), although the prevalence of autoantibodies in the Group A mothers having abnormal babies compared with those who had normal babies did not differ. Anti-La was present only in mothers with abnormal babies (7 of 17 compared to 0 of 10, p less than 0.025). Anti-La did not occur without anti-Ro, but anti-Ro occurred in 9 mothers without anti-La. Anti-Ro was present in the serum of all mothers of infants with CCHB and occurred alone in 3 of 4 instances. Titers of anti-Ro did not differ between abnormal and normal infants or their mothers. ACL occurred alone in the serum of 10 of 38 mothers, and was present in 7 mothers who had infants with cardiac abnormalities other than CCHB.

Maternal antibodies to Ro (SS-A) are associated with both early onset of disease and male sex among children with systemic lupus erythematosus

In this study of 71 children with systemic lupus erythematosus (SLE) and 188 of their first-degree relatives, we demonstrated that the development of SLE in male children younger than age 18, and in all children younger than age 10 at the time of diagnosis, is strongly correlated with the presence of antibodies to Ro (SS-A) in the mother's serum. When the relative antibody concentration was quantified, increased quantities of antibody to Ro (SS-A) were also found in mothers of male probands and mothers of probands whose SLE was diagnosed before age 10. No similar association was found for the presence or amount of antibody to Ro (SS-A) in other first-degree relatives or for antibody to La (SS-B) or nuclear RNP in any relative. The explanation for the association of maternal anti-Ro (SS-A) antibodies and early diagnosis of SLE or male sex is not apparent. These findings extend the association of maternal antibodies to Ro (SS-A) from transient "neonatal" SLE to SLE in childhood, and suggest that maternal antibodies to Ro (SS-A) may be of fundamental importance in the pathogenesis of some cases of childhood SLE.

Psoriatic arthritis in children

A proposed definition of juvenile psoriatic arthritis (JPsA) was used to identify definite or probable JPsA in 35 children. Definite JPsA (24 patients) was defined as arthritis associated, but not necessarily coincident, with a typical psoriatic rash, or arthritis plus at least 3 of 4 minor criteria: dactylitis, nail pitting, psoriasis-like rash, or family history of psoriasis. Probable JPsA (11 patients) was defined as arthritis plus 2 of the minor criteria. In 33 of 35 patients, the onset of arthritis was pauciarticular, but the disease followed a polyarticular course in 23 of 35. Chronic anterior uveitis (6 of 35), antinuclear antibodies (22 of 35), anticollagen antibodies (10 of 35), HLA-DR4 (2 of 28), and HLA-DR8 (5 of 28) occurred with frequencies similar to those seen in patients with juvenile rheumatoid arthritis. JPsA may have more in common with juvenile rheumatoid arthritis than with the seronegative spondylarthropathies with which it is traditionally associated.

Reactivity of antinuclear antibodies with histones and other antigens in juvenile rheumatoid arthritis

Antinuclear antibodies are found in serum samples from most children with juvenile rheumatoid arthritis (JRA), but the antigenic specificities of these antibodies are not known. Using an immunoblot technique, we found that JRA patients' sera react with a variety of proteins in the nuclei of HEp-2 cells. Antibody to histone H1 was found in 42% of the JRA serum samples. An IgG antibody to a 45-kd protein was found in serum samples from some patients without uveitis, but it was not found in any sample from patients with uveitis. The immunoblot reactivity patterns do not appear to be useful in distinguishing between disease onset types or disease course types in patients with JRA.

Uveitis and arthritis induced by adjuvant: clinical, immunologic and histologic characteristics

The intradermal administration of complete Freund's adjuvant (CFA) containing Mycobacterium butyricum to Sprague-Dawley (SD) and Lewis strain rats results in polyarthritis and uveitis. Over 90% of the eyes examined from the SD rats given CFA had histologic evidence of anterior uveitis, clinically evident in only 20 to 28%. Many rats developed arthritis without clinical uveitis, but uveitis was rare in the absence of arthritis. Histologically, the ocular inflammation was characterized by a polymorphonuclear, and later, a lymphocytic infiltration of the iris and ciliary body with cells and fibrinous exudate in the anterior chamber and cells in the vitreous. Antibodies and cellular immunity to ocular (S antigen, alpha crystallin), articular (type II collagen, proteoglycan) and bacterial components (MDP), were demonstrated in some rats, but positive tests did not correlate with either articular or ocular disease. Ten percent of rats given type II collagen in incomplete Freund's adjuvant developed uveitis. Thus, the pathogenesis of the arthritis and uveitis in the adjuvant model may be mediated by lymphocytes which exhibit crossreactivity with antigens in these structures, although the specificity of such antigens has not been identified in our studies.